Brief Title
Effect of Antifibrotic Therapy on Regression of Myocardial Fibrosis After Transcatheter Aortic Valve Implantation (TAVI) in Aortic Stenosis Patients With High Fibrotic Burden
Official Title
Effect of Antifibrotic Therapy on Regression of Myocardial Fibrosis After Transcatheter Aortic Valve Implantation (TAVI) in Aortic Stenosis Patients With High Fibrotic Burden
Brief Summary
The aim of the study is to evaluate the effect of antifibrotic therapy on regression of myocardial fibrosis after TAVI in patients with baseline high fibrotic burden. Therefore, patients will be treated with Spironolactone in addition to standard of care, Spioronolactone + Dihydralazine in addition to standard of care or according to standard of care alone without any study medication. First, differences between patients in the control arm and patients randomized to anti-fibrotic therapy will be analyzed. The second analysis will determine, whether dihydralazine medication in addition to spironolactone is able to increase a potential antifibrotic effect. Myocardial fibrosis will be assessed by cardiac magnetic resonance imaging (CMR) before TAVI and 1 year after. Quantification of potentially irreversible replacement fibrosis will be carried out by late gadolinium enhancement (LGE), and quantification of the potentially reversible diffuse interstitial fibrosis will be performed by measurement of the extracellular volume fraction (ECV), thereby deriving matrix volume and cell volume.
Study Phase
Phase 3
Study Type
Interventional
Primary Outcome
Extracellular volume (ECV)-derived matrix volume (measured by CMR)
Secondary Outcome
Left ventricular ejection fraction
Condition
Aortic Stenosis, Severe
Intervention
Standard of Care
Study Arms / Comparison Groups
Control group
Description: Patients with CMR-derived ECV% levels ≥25.9% will receive Standard of care
Publications
* Includes publications given by the data provider as well as publications identified by National Clinical Trials Identifier (NCT ID) in Medline.
Recruitment Information
Recruitment Status
Other
Estimated Enrollment
300
Start Date
February 23, 2022
Completion Date
March 2026
Primary Completion Date
June 2025
Eligibility Criteria
Inclusion Criteria: - Male, female age ≥ 60 - Diagnosis of severe symptomatic aortic stenosis - Transcatheter aortic valve implantation (TAVI) scheduled - Written informed consent Exclusion Criteria: - 1. Pre-existing dilative or ischemic heart disease with EF<35% and guideline indication for spironolactone - Patient on current medication with spironolactone, eplerenone, or dihydralazine - Presence of coexistent myocardial pathology such as cardiac amyloidosis, hypertrophic cardiomyopathy, or myocarditis - Presence of coexistent severe aortic regurgitation or severe mitral stenosis - Previous surgical valve replacement or repair - Pacemaker or ICD implanted - Renal impairment (serum creatinine > 1,8 mg/dl and/ or GFR < 30 ml/min/1,73 m² BSA) - Significant hypotension (blood pressure < 90 mm Hg systolic and/or < 50 mm Hg diastolic - Serum potassium > 5,1 mmol/l - Contraindications for Spironolactone (anuria, acute renal failure, serum creatinine > 1.8 mg/dl, hyperkalemia, pregnancy) - Contraindications for Dihydralazine (known allergy or hypersensitivity, systemic lupus erythematodes, adrenocortical disorders) - Known active malignant disease with life expectancy < 1 year - Women with child-bearing potential - Simultaneous participation (including a waiting period of 4 weeks) in other interventional clinical trials - Patient without legal capacity who is unable to understand the nature, significance and consequences of the trial - Person who is in a relationship of dependence/employment with the sponsor or the investigator
Gender
All
Ages
60 Years - N/A
Accepts Healthy Volunteers
No
Contacts
, +49 551 3910958, [email protected]
Location Countries
Germany
Location Countries
Germany
Administrative Informations
NCT ID
NCT05230901
Organization ID
02717
Responsible Party
Principal Investigator
Study Sponsor
University Medical Center Goettingen
Study Sponsor
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Verification Date
June 2022